A retrospective study: exploring the optimal patient population for adjuvant chemotherapy after D2 gastrectomy

Yingsong Zheng; Yubo Ma; Chuhong Pang; KaiLai Yin; Kang Liu; Jinxia Chen; Mengli Zi; Yizhou Wei; Xiangdong Cheng; Li Yuan

doi:10.1016/j.gassur.2024.01.021

A retrospective study: exploring the optimal patient population for adjuvant chemotherapy after D2 gastrectomy

J Gastrointest Surg. 2024 Apr;28(4):365-374. doi: 10.1016/j.gassur.2024.01.021. Epub 2024 Jan 23.

Authors

Yingsong Zheng¹, Yubo Ma², Chuhong Pang¹, KaiLai Yin¹, Kang Liu², Jinxia Chen¹, Mengli Zi¹, Yizhou Wei¹, Xiangdong Cheng³, Li Yuan⁴

Affiliations

¹ Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China; Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, Zhejiang, China; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, China.
² Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, Zhejiang, China; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, China; The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
³ Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, Zhejiang, China; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, China.
⁴ Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, Zhejiang, China; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, China. Electronic address: yuanli2768@zjcc.org.cn.

PMID: 38583885
DOI: 10.1016/j.gassur.2024.01.021

Abstract

Background: Adjuvant chemotherapy (CT) constitutes the primary approach for treating resectable advanced gastric cancer (GC). However, the effectiveness of postoperative CT can differ across various patient groups. This retrospective study aimed to examine how variances in clinical and pathologic factors affect postoperative CT.

Methods: This study enrolled 2060 patients with GC who underwent curative gastrectomy at Zhejiang Cancer Hospital between January 2008 and December 2017, with 1277 receiving postoperative CT. This study used Kaplan-Meier to determine the effect of clinical and pathology factors on CT benefits. In addition, univariate and multivariate Cox regression analyses were used to identify independent prognosis risk factors.

Results: Both univariate and multivariate analyses demonstrated that the absence of postoperative CT is an independent factor associated with a poor prognosis in patients with GC. The Kaplan-Meier univariate analysis revealed that specific subgroups, including males, those with a normal body mass index (BMI), the elderly, individuals with gastric adenocarcinoma, cases of nerve invasion by the tumor, vascular invasion by the tumor, tumor size ≥ 5 cm, and Tumor, Node, Metastasis (TNM) stage III, exhibited improved treatment outcomes with the administration of postoperative CT. The creation of nomograms using Cox regression and the rms package holds significant clinical relevance.

Conclusion: Postoperative CT is advantageous for prolonging the survival of advanced patients undergoing D2 gastrectomy, particularly in male patients, the elderly, individuals with a normal BMI score, those diagnosed with gastric adenocarcinoma, cases, in which the tumor invades nerves or blood vessels, patients with a tumor size of ≥5 cm, and those with a TNM stage of III, as it results in improved treatment outcomes within these subgroups.

Keywords: Gastric cancer; Nomogram; Postoperative chemotherapy.

MeSH terms

Adenocarcinoma* / drug therapy
Adenocarcinoma* / surgery
Aged
Chemotherapy, Adjuvant
Gastrectomy / methods
Humans
Male
Neoplasm Staging
Prognosis
Retrospective Studies
Stomach Neoplasms* / drug therapy
Stomach Neoplasms* / surgery